Endocrine

, Volume 46, Issue 3, pp 423–430 | Cite as

Endocrine evaluation of erectile dysfunction

  • Andrea Sansone
  • Francesco Romanelli
  • Daniele Gianfrilli
  • Andrea Lenzi
Mini Review
First Online:
Received:
Accepted:

Abstract

Erectile dysfunction is highly prevalent, affecting up to half of men in their 50–70s, and has been variably associated to a variety of causes including unhealthy lifestyles, such as smoking or overweight, or comorbidities such as hypertension, diabetes mellitus, and neurological disorders. General interest toward ED has exploded since the introduction of phosphodiesterase type 5 inhibitors—oral drugs that are widely accepted as the first line treatment in patients suffering from this conditions. In the last decade, the time lapse between first symptoms of sexual disorders and seeking of medical advice has greatly reduced. Unfortunately, none of the PDE5i has been proven curative, but rather acts as a symptomatic treatment. The availability of very active and safe drugs, however, diminished the space for diagnosis and search of etiological treatments. This is particularly true for the several endocrinopathies associated with ED. A number of epidemiological data support an inverse relationship between sexual health and testosterone levels, and it is well accepted that testosterone deficiency is a good marker of sexual and physical frailty. However, several other hormones, including LH, prolactin, TSH, and FT4 are involved in sexual functioning and should be investigated in a proper work-out of ED. Existing guidelines provide information almost entirely focusing on late-onset hypogonadism and therapeutic strategies; this mini-review aims to provide a wider spectrum of the diagnostic endocrine work-out of ED patients unrevealing the complexity of conditions, overt or subclinical, which can affect ED.

Keywords

Erectile dysfunction Hormones Testosterone 
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Notes

Conflict of interest

None.

References

  1. 1.
    American Psychiatric Association, Diagnostic and statistical manual of mental health disorders: DSM-5, 5th edn. (American Psychiatric Publishing, Washington DC, 2013)Google Scholar
  2. 2.
    H. Ghanem, R. Shamloul, Erectile dysfunction. Lancet 381, 153–165 (2013)PubMedCrossRefGoogle Scholar
  3. 3.
    R.W. Lewis, K.S. Fugl-Meyer, G. Corona, R.D. Hayes, E.O. Laumann, E.D. Moreira Jr, A.H. Rellini, T. Segraves, Definitions/epidemiology/risk factors for sexual dysfunction. J. Sex. Med. 7, 1598–1607 (2010)PubMedCrossRefGoogle Scholar
  4. 4.
    F. Romanelli, A. Sansone, A. Lenzi, Erectile dysfunction in aging male. Acta Biomed. 81(Suppl 1), 89–94 (2010)PubMedGoogle Scholar
  5. 5.
    A. Salonia, M. Ferrari, A. Saccà, F. Pellucchi, G. Castagna, M.C. Clementi, R. Matloob, A. Briganti, P. Rigatti, F. Montorsi, Delay in seeking medical help in patients with new-onset erectile dysfunction remained high over and despite the PDE5 era–an ecological study. J. Sex. Med. 9, 3239–3246 (2012)PubMedCrossRefGoogle Scholar
  6. 6.
    C. Gazzaruso, A. Coppola, T. Montalcini, C. Valenti, A. Garzaniti, G. Pelissero, F. Salvucci, P. Gallotti, A. Pujia, C. Falcone, S.B. Solerte, A. Giustina, Erectile dysfunction can improve the effectiveness of the current guidelines for the screening for asymptomatic coronary artery disease in diabetes. Endocrine 40, 273–279 (2011)PubMedCrossRefGoogle Scholar
  7. 7.
    G. Gandaglia, A. Salonia, N. Passoni, P. Montorsi, A. Briganti, F. Montorsi, Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine 43, 285–292 (2013)PubMedCrossRefGoogle Scholar
  8. 8.
    E.A. Jannini, A.M. Isidori, A. Aversa, A. Lenzi, S.E. Althof, Which is first? The controversial issue of precedence in the treatment of male sexual dysfunctions. J. Sex. Med. 10, 2359–2369 (2013)PubMedGoogle Scholar
  9. 9.
    S.P. McLaughlin, C.C. Carsson, Laboratory evaluation of the patient with erectile dysfunction. Endocrine 23, 113–117 (2004)PubMedCrossRefGoogle Scholar
  10. 10.
    H.M. Ghanem, A. Salonia, A. Martin-Morales, SOP: physical examination and laboratory testing for men with erectile dysfunction. J. Sex. Med. 10, 108–110 (2013)PubMedCrossRefGoogle Scholar
  11. 11.
    A.M. Isidori, J. Buvat, G. Corona, I. Goldstein, E.A. Jannini, A. Lenzi, H. Porst, A. Salonia, A.M. Traish, M. Maggi, A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment—a systematic review. Eur. Urol. 65, 99–112 (2014)PubMedCrossRefGoogle Scholar
  12. 12.
    R.W. Lewis, T.M. Mills, Effect of androgens on penile tissue. Endocrine 23, 101–105 (2004)PubMedCrossRefGoogle Scholar
  13. 13.
    F.C. Wu, A. Tajar, J.M. Beynon, S.R. Pye, A.J. Silman, J.D. Finn, T.W. O’Neill, G. Bartfai, F.F. Casanueva, G. Forti, A. Giwercman, T.S. Han, K. Kula, M.E. Lean, N. Pendleton, M. Punab, S. Boonen, D. Vanderschueren, F. Labrie, I.T. Huhtaniem, EMAS Group, Identification of late-onset hypogonadism in middle-aged and elderly men. N. Engl. J. Med. 363, 123–135 (2010)PubMedCrossRefGoogle Scholar
  14. 14.
    J. Buvat, M. Maggi, A. Guay, L.O. Torres, Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. J. Sex. Med. 10, 245–284 (2013)PubMedCrossRefGoogle Scholar
  15. 15.
    M. Zitzmann, S. Faber, E. Nieschlag, Association of specific symptoms and metabolic risks with serum testosterone in older men. J. Clin. Endocrinol. Metab. 91, 4335–4343 (2006)PubMedCrossRefGoogle Scholar
  16. 16.
    A. Morelli, G. Corona, L. Vignozzi, S. Ambrosini, S. Filippi, G. Forti, M. Maggi, Which patients with sexual dysfunction are suitable for testosterone replacement therapy? J. Endocrinol. Invest. 30, 880–888 (2007)PubMedCrossRefGoogle Scholar
  17. 17.
    G. Corona, E. Mannucci, L. Petrone, R. Giommi, R. Mansani, L. Fei, G. Forti, M. Maggi, Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int. J. Impot. Res. 16, 275–281 (2004)PubMedCrossRefGoogle Scholar
  18. 18.
    J. Buvat, M. Maggi, L. Gooren, A.T. Guay, J. Kaufman, A. Morgentaler, C. Schulman, H.M. Tan, L.O. Torres, A. Yassin, M. Zitzmann, Endocrine aspects of male sexual dysfunctions. J. Sex. Med. 7, 1627–1656 (2010)PubMedCrossRefGoogle Scholar
  19. 19.
    G. Corona, E. Mannucci, L. Petrone, G. Balercia, A.D. Fisher, V. Chiarini, G. Forti, M. Maggi, ANDROTEST: a structured interview for the screening of hypogonadism in patients with sexual dysfunction. J. Sex. Med. 3, 706–715 (2006)PubMedCrossRefGoogle Scholar
  20. 20.
    G. Corona, G. Rastrelli, L. Vignozzi, E. Mannucci, M. Maggi, How to recognize late-onset hypogonadism in men with sexual dysfunction. Asian J. Androl. 14, 251–259 (2012)PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    R.C. Rosen, Evaluation of the patient with erectile dysfunction. Endocrine 23, 107–111 (2004)PubMedCrossRefGoogle Scholar
  22. 22.
    C. Wang, E. Nieschlag, R. Swerdloff, H.M. Behre, W.J. Hellstrom, L.J. Gooren, J.M. Kaufman, J.J. Legros, B. Lunenfeld, A. Morales, J.E. Morley, C. Schulman, I.M. Thompson, W. Weidner, F.C. Wu, Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur. J. Endocrinol. 159, 507–514 (2008)PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    E. Wespes, I. Eardley, F. Giuliano, D. Hatzichristou, K. Hatzimouratidis, I. Moncada, A. Salonia, Y. Vardi, European Association of Urology, Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Uroweb 2013. Available at www.uroweb.org/gls/pdf/14_Male%20Sexual%20Dysfunction_LR.pdf
  24. 24.
    S. Bhasin, G.R. Cunningham, F.J. Hayes, A.M. Matsumoto, P.J. Snyder, R.S. Swerdloff, V.M. Montori, Task Force Endocrine Society, Testosterone therapy in men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 95, 2536–2559 (2010)PubMedCrossRefGoogle Scholar
  25. 25.
    F. Montorsi, G. Adaikan, E. Becher, F. Giuliano, S. Khoury, T.F. Lue, I. Sharlip, S.E. Althof, K.E. Andersson, G. Brock, G. Broderick, A. Burnett, J. Buvat, J. Dean, C. Donatucci, I. Eardley, K.S. Fugl-Meyer, I. Goldstein, G. Hackett, D. Hatzichristou, W. Hellstrom, L. Incrocci, G. Jackson, A. Kadioglu, L. Levine, R.W. Lewis, M. Maggi, M. McCabe, C.G. McMahon, D. Montague, P. Montorsi, J. Mulhall, J. Pfaus, H. Porst, D. Ralph, R. Rosen, D. Rowland, H. Sadeghi-Nejad, R. Shabsigh, C. Stief, Y. Vardi, K. Wallen, M. Wasserman, Summary of the recommendations on sexual dysfunctions in men. J Sex. Med. 7, 3572–3588 (2010)PubMedCrossRefGoogle Scholar
  26. 26.
    R. Kacker, A. Hornstein, A. Morgentaler, Free testosterone by direct and calculated measurement versus equilibrium dialysis in a clinical population. Aging Male (2013). doi: 10.3109/13685538.2013.835800 PubMedGoogle Scholar
  27. 27.
    A. Vermeulen, L. Verdonck, J.M. Kaufman, A critical evaluation of simple methods for the estimation of free testosterone in serum. J. Clin. Endocrinol. Metab. 84, 3666–3672 (1999)PubMedCrossRefGoogle Scholar
  28. 28.
  29. 29.
    E. Giannetta, D. Gianfrilli, F. Barbagallo, A.M. Isidori, A. Lenzi, Subclinical male hypogonadism. Best Pract. Res. Clin. Endocrinol. Metab. 26, 539–550 (2012)PubMedCrossRefGoogle Scholar
  30. 30.
    K. Sivaraaman, S. Mintzer, Hormonal consequences of epilepsy and its treatment in men. Curr. Opin. Endocrinol. Diabetes Obes. 18, 204–209 (2011)PubMedCrossRefGoogle Scholar
  31. 31.
    M. Pugeat, N. Nader, K. Hogeveen, G. Raverot, H. Déchaud, C. Grenot, Sex hormone-binding globulin gene expression in the liver: drugs and the metabolic syndrome. Mol. Cell. Endocrinol. 316, 53–59 (2010)PubMedCrossRefGoogle Scholar
  32. 32.
    M. Pugeat, J.C. Crave, J. Tourniaire, M.G. Forest, Clinical utility of sex hormone-binding globulin measurement. Horm. Res. 45, 148–155 (1996)PubMedCrossRefGoogle Scholar
  33. 33.
    R. Hampl, R. Kancheva, M. Hill, M. Bicíková, K. Vondra, Interpretation of sex hormone-binding globulin levels in thyroid disorders. Thyroid 13, 755–760 (2003)PubMedCrossRefGoogle Scholar
  34. 34.
    R. Dittrich, M.W. Beckmann, P.G. Oppelt, I. Hoffmann, L. Lotz, T. Kuwert, A. Mueller, Thyroid hormone receptors and reproduction. J. Reprod. Immunol. 90, 58–66 (2011)PubMedCrossRefGoogle Scholar
  35. 35.
    C. Foresta, M. Schipilliti, F.A. Ciarleglio, A. Lenzi, D. D’Amico, Male hypogonadism in cirrhosis and after liver transplantation. J. Endocrinol. Invest. 31, 470–478 (2008)PubMedCrossRefGoogle Scholar
  36. 36.
    M. Flechtner-Mors, A. Schick, S. Oeztuerk, M.M. Haenle, M. Wilhelm, W. Koenig, A. Imhof, B.O. Boehm, T. Graeter, R.A. Mason, W. Kratzer, A.S. Akinli, The EMIL-Study Group, Associations of fatty liver disease and other factors affecting serum SHBG concentrations: a population based study on 1657 subjects. Horm. Metab. Res. (2013). doi: 10.1055/s-0033-1354369 PubMedGoogle Scholar
  37. 37.
    J. Pepe, A.M. Isidori, M. Falciano, G. Iaiani, A. Salotti, D. Diacinti, R. Del Fiacco, E. Sbardella, C. Cipriani, S. Piemonte, E. Romagnoli, A. Lenzi, S. Minisola, The combination of FRAX and ageing male symptoms scale better identifies treated HIV males at risk for major fracture. Clin. Endocrinol. Oxf. 77, 672–678 (2012)PubMedCrossRefGoogle Scholar
  38. 38.
    P.B. Gray, A.B. Singh, L.J. Woodhouse, T.W. Storer, R. Casaburi, J. Dzekov, C. Dzekov, I. Sinha-Hikim, S. Bhasin, Dose-dependent effects of testosterone on sexual function, mood, and visuospatial cognition in older men. J. Clin. Endocrinol. Metab. 90, 3838–3846 (2005)PubMedCrossRefGoogle Scholar
  39. 39.
    J. Buvat, R. Shabsigh, A. Guay, L. Gooren, L.O. Torres, E. Meuleman, Hormones, metabolism, aging, and men’s health, in Standard practice in sexual medicine, ed. by H. Porst, J. Buvat (Blackwell, Malden, 2006), pp. 225–286CrossRefGoogle Scholar
  40. 40.
    B. Srilatha, P.G. Adaikan, Endocrine milieu and erectile dysfunction: is oestradiol-testosterone imbalance, a risk factor in the elderly? Asian J. Androl. 13, 569–573 (2011)PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    A.I. El-Sakka, Impact of the association between elevated oestradiol and low testosterone levels on erectile dysfunction severity. Asian J Androl. 15, 492–496 (2013)PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    W. Rosner, S.E. Hankinson, P.M. Sluss, H.W. Vesper, M.E. Wierman, Challenges to the measurement of estradiol: an endocrine society position statement. J. Clin. Endocrinol. Metab. 98, 1376–1387 (2013)PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    D.B. O’Connor, D.M. Lee, G. Corona, G. Forti, A. Tajar, T.W. O’Neill, N. Pendleton, G. Bartfai, S. Boonen, F.F. Casanueva, J.D. Finn, A. Giwercman, T.S. Han, I.T. Huhtaniemi, K. Kula, F. Labrie, M.E. Lean, M. Punab, A.J. Silman, D. Vanderschueren, F.C. Wu, European Male Ageing Study Group, The relationships between sex hormones and sexual function in middle-aged and older European men. J. Clin. Endocrinol. Metab. 96, E1577–E1587 (2011)PubMedCrossRefGoogle Scholar
  44. 44.
    M. Perusquía, J.N. Stallone, Do androgens play a beneficial role in the regulation of vascular tone? Nongenomic vascular effects of testosterone metabolites. Am. J. Physiol. Heart Circ. Physiol. 298, H1301–H1307 (2010)PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    S. Melmed, F.F. Casanueva, A.R. Hoffman, D.L. Kleinberg, V.M. Montori, J.A. Schlechte, J.A. Wass, Endocrine Society, Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 273–288 (2011)PubMedCrossRefGoogle Scholar
  46. 46.
    M. Maggi, J. Buvat, G. Corona, A. Guay, L.O. Torres, Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA). J. Sex. Med. 10, 661–677 (2013)PubMedCrossRefGoogle Scholar
  47. 47.
    Z. Hekimsoy, S. Kafesçiler, F. Güçlü, B. Ozmen, The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidism. Endocr. J. 57, 1011–1015 (2010)PubMedCrossRefGoogle Scholar
  48. 48.
    A. Bolyakov, D.A. Paduch, Prolactin in men’s health and disease. Curr. Opin. Urol. 21, 527–534 (2011)PubMedCrossRefGoogle Scholar
  49. 49.
    A. Ciccarelli, E. Guerra, M. De Rosa, F. Milone, S. Zarrilli, G. Lombardi, A. Colao, PRL secreting adenomas in male patients. Pituitary 8, 39–42 (2005)PubMedCrossRefGoogle Scholar
  50. 50.
    L. Vilar, M.C. Freitas, L.A. Naves, L.A. Casulari, M. Azevedo, R. Montenegro Jr, A.I. Barros, M. Faria, G.C. Nascimento, J.G. Lima, L.H. Nóbrega, T.P. Cruz, A. Mota, A. Ramos, A. Violante, A. Lamounier Filho, M.R. Gadelha, A. Glezer, M.D. Bronstein, Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients. J. Endocrinol. Invest. 31, 436–444 (2008)PubMedCrossRefGoogle Scholar
  51. 51.
    G. Corona, E. Mannucci, A.D. Fisher, F. Lotti, V. Ricca, G. Balercia, L. Petrone, G. Forti, M. Maggi, Effect of hyperprolactinemia in male patients consulting for sexual dysfunction. J. Sex. Med. 4, 1485–1493 (2007)PubMedCrossRefGoogle Scholar
  52. 52.
    F. Drago, B. Pellegrini-Quarantotti, U. Scapagnini, G.L. Gessa, Short-term endogenous hyperprolactinaemia and sexual behavior of male rats. Physiol. Behav. 26, 277–279 (1981)PubMedCrossRefGoogle Scholar
  53. 53.
    J. Buvat, Hyperprolactinemia and sexual function in men: a short review. Int. J. Impot. Res. 15, 373–377 (2003)PubMedCrossRefGoogle Scholar
  54. 54.
    H. Aoki, T. Fujioka, J. Matsuzaka, T. Kubo, K. Nakamura, N. Yasuda, Suppression by prolactin of the electrically induced erectile response through its direct effect on the corpus cavernosum penis in the dog. J. Urol. 154, 595–600 (1995)PubMedCrossRefGoogle Scholar
  55. 55.
    S. Ra, H. Aoki, T. Fujioka, F. Sato, T. Kubo, N. Yasuda, In vitro contraction of the canine corpus cavernosum penis by direct perfusion with prolactin or growth hormone. J. Urol. 156, 522–525 (1996)PubMedCrossRefGoogle Scholar
  56. 56.
    M. De Rosa, S. Zarrilli, G. Vitale, C. Di Somma, F. Orio, L. Tauchmanova, G. Lombardi, A. Colao, Six months of treatment with Cabergoline restores sexual potency in hyperprolactinemic males: an open longitudinal study monitoring nocturnal penile tumescence. J. Clin. Endocrinol. Metab. 89, 621–625 (2004)PubMedCrossRefGoogle Scholar
  57. 57.
    M. Galdiero, R. Pivonello, L.F.S. Grasso, A. Cozzolino, A. Colao, Growth hormone, prolactin, and sexuality. J. Endocrinol. Invest. 35, 782–794 (2012)PubMedCrossRefGoogle Scholar
  58. 58.
    A. Fumarola, A. Di Fiore, M. Dainelli, G. Grani, A. Calvanese, Medical treatment of hyperthyroidism: state of the art. Exp. Clin. Endocrinol. Diabetes 118, 678–684 (2010)PubMedCrossRefGoogle Scholar
  59. 59.
    B.O. Asvold, L.J. Vatten, T. Bjøro, Changes in the prevalence of hypothyroidism: the HUNT Study in Norway. Eur. J. Endocrinol. 169, 613–620 (2013)PubMedCrossRefGoogle Scholar
  60. 60.
    G. Corona, L. Petrone, E. Mannucci, E.A. Jannini, R. Mansani, A. Magini, R. Giommi, G. Forti, M. Maggi, Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur. Urol. 46, 615–622 (2004)PubMedCrossRefGoogle Scholar
  61. 61.
    C. Carani, A.M. Isidori, A. Granata, E. Carosa, M. Maggi, A. Lenzi, E.A. Jannini, Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J. Clin. Endocrinol. Metab. 90, 6472–6479 (2005)PubMedCrossRefGoogle Scholar
  62. 62.
    A. Veronelli, A. Masu, R. Ranieri, C. Rognoni, M. Laneri, A.E. Pontiroli, Prevalence of erectile dysfunction in thyroid disorders: comparison with control subjects and with obese and diabetic patients. Int. J. Impot. Res. 18, 111–114 (2006)PubMedCrossRefGoogle Scholar
  63. 63.
    G.E. Krassas, K. Tziomalos, F. Papadopoulou, N. Pontikides, P. Perros, Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat? J. Clin. Endocrinol. Metab. 93, 1815–1819 (2008)PubMedCrossRefGoogle Scholar
  64. 64.
    G. Corona, F.C. Wu, G. Forti, D.M. Lee, D.B. O’Connor, T.W. O’Neill, N. Pendleton, G. Bartfai, S. Boonen, F.F. Casanueva, J.D. Finn, A. Giwercman, T.S. Han, I.T. Huhtaniemi, K. Kula, M.E. Lean, M. Punab, D. Vanderschueren, E.A. Jannini, E. Mannucci, M. Maggi, EMAS Study Group, Thyroid hormones and male sexual function. Int. J. Androl. 35, 668–679 (2012)PubMedCrossRefGoogle Scholar
  65. 65.
    M. Sherlock, A.A. Toogood, Aging and the growth hormone/insulin like growth factor-I axis. Pituitary 10, 189–203 (2007)PubMedCrossRefGoogle Scholar
  66. 66.
    A. Colao, M. De Rosa, R. Pivonello, A. Balestrieri, P. Cappabianca, A. Di Sarno, V. Rochira, C. Carani, G. Lombardi, Short-term suppression of GH and IGF-I levels improves gonadal function and sperm parameters in men with acromegaly. J. Clin. Endocrinol. Metab. 87, 4193–4197 (2002)PubMedCrossRefGoogle Scholar
  67. 67.
    C.L. Brooks, Molecular mechanisms of prolactin and its receptor. Endocr. Rev. 33, 504–525 (2012)PubMedCentralPubMedCrossRefGoogle Scholar
  68. 68.
    M.E. Molitch, D.R. Clemmons, S. Malozowski, G.R. Merriam, M.L. Vance, Endocrine Society, Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1587–1609 (2011)PubMedCrossRefGoogle Scholar
  69. 69.
    M.L. Reed, G.R. Merriam, A.Y. Kargi, Adult growth hormone deficiency—benefits, side effects, and risks of growth hormone replacement. Front. Endocrinol. Lausanne 4, 64 (2013)PubMedCentralPubMedGoogle Scholar
  70. 70.
    K.T. Brill, A.L. Weltman, A. Gentili, J.T. Patrie, D.A. Fryburg, J.B. Hanks, R.J. Urban, J.D. Veldhuis, Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. J. Clin. Endocrinol. Metab. 87, 5649–5657 (2002)PubMedCrossRefGoogle Scholar
  71. 71.
    M. Maggio, E. Colizzi, A. Fisichella, G. Valenti, G. Ceresini, E. Dall’Aglio, L. Ruffini, F. Lauretani, L. Parrino, G.P. Ceda, Stress hormones, sleep deprivation and cognition in older adults. Maturitas 76, 22–44 (2013)PubMedCrossRefGoogle Scholar
  72. 72.
    J.E. Morley, Scientific overview of hormone treatment used for rejuvenation. Fertil. Steril. 99, 1807–1813 (2013)PubMedCrossRefGoogle Scholar
  73. 73.
    H.A. Feldman, I. Goldstein, D.G. Hatzichristou, R.J. Krane, J.B. McKinlay, Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J. Urol. 151, 54–61 (1994)PubMedGoogle Scholar
  74. 74.
    W.J. Reiter, A. Pycha, G. Schatzl, A. Pokorny, D.M. Gruber, J.C. Huber, M. Marberger, Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study. Urology 53, 590–594 (1999)PubMedCrossRefGoogle Scholar
  75. 75.
    A. Morales, A. Black, L. Emerson, J. Barkin, I. Kuzmarov, A. Day, Androgens and sexual function: a placebo- controlled, randomized, double-blind study of testosterone vs. dehydroepiandrosterone in men with sexual dysfunction and androgen deficiency. Aging Male 12, 104–112 (2009)PubMedCrossRefGoogle Scholar
  76. 76.
    A. Tomova, P. Kumanov, Are dehydroepiandrosterone sulphate and lipids associated with erectile dysfunction? Maturitas 50, 294–299 (2005)PubMedCrossRefGoogle Scholar
  77. 77.
    GISEG (Italian Study Group on Geriatric Endocrinology), G. Valenti, L. Denti, M. Saccò, G. Ceresini, S. Bossoni, A. Giustina, D. Maugeri, G.B. Vigna, R. Fellin, G. Paolisso, M. Barbagallo, M. Maggio, F. Strollo, L. Bollanti, F. Romanelli, M. Latini, Consensus document on substitution therapy with DHEA in the elderly. Aging. Clin. Exp. Res. 18, 277–300 (2006)PubMedCrossRefGoogle Scholar
  78. 78.
    N. Samaras, D. Samaras, E. Frangos, A. Forster, J. Philippe, A review of age-related dehydroepiandrosterone decline and its association with well-known geriatric syndromes: is treatment beneficial? Rejuvenation Res. 16, 285–294 (2013)PubMedCrossRefGoogle Scholar
  79. 79.
    S. Ückert, M.H. Fuhlenriede, A.J. Becker, C.G. Stief, F. Scheller, W.H. Knapp, U. Jonas, Is there an inhibitory role of cortisol in the mechanism of male sexual arousal and penile erection? Urol. Res. 31, 402–406 (2003)PubMedCrossRefGoogle Scholar
  80. 80.
    Y. Kobori, E. Koh, K. Sugimoto, K. Izumi, K. Narimoto, Y. Maeda, H. Konaka, A. Mizokami, T. Matsushita, T. Iwamoto, M. Namiki, The relationship of serum and salivary cortisol levels to male sexual dysfunction as measured by the International Index of Erectile Function. Int. J. Impot. Res. 21, 207–212 (2009)PubMedCentralPubMedCrossRefGoogle Scholar
  81. 81.
    G. Tirabassi, M. Boscaro, G. Arnaldi, Harmful effects of functional hypercortisolism: a working hypothesis. Endocrine (2013). doi: 10.1007/s12020-013-0112-y PubMedGoogle Scholar
  82. 82.
    O. Ragnarsson, G. Johannsson, Cushing’s syndrome: a structured short- and long-term management plan for patients in remission. Eur. J. Endocrinol. 169, R139–R152 (2013)PubMedCrossRefGoogle Scholar
  83. 83.
    E. Valassi, I. Crespo, A. Santos, S.M. Webb, Clinical consequences of Cushing’s syndrome. Pituitary 15, 319–329 (2012)PubMedCrossRefGoogle Scholar
  84. 84.
    M. Quinkler, F. Beuschlein, S. Hahner, G. Meyer, C. Schöfl, G.K. Stalla, Adrenal cortical insufficiency—a life threatening illness with multiple etiologies. Dtsch. Arztebl. Int. 110, 882–888 (2013)PubMedCentralPubMedGoogle Scholar
  85. 85.
    A. Granata, G. Tirabassi, V. Pugni, G. Arnaldi, M. Boscaro, C. Carani, G. Balercia, Sexual dysfunctions in men affected by autoimmune Addison’s disease before and after short-term gluco- and mineralocorticoid replacement therapy. J. Sex. Med. 10, 2036–2043 (2013)PubMedCrossRefGoogle Scholar
  86. 86.
    R. Giordano, F. Guaraldi, R. Berardelli, I. Karamouzis, V. D’Angelo, E. Marinazzo, A. Picu, E. Ghigo, E. Arvat, Glucose metabolism in patients with subclinical Cushing’s syndrome. Endocrine 41, 415–423 (2012)PubMedCrossRefGoogle Scholar
  87. 87.
    C. Gazzaruso, S.B. Solerte, A. Pujia, A. Coppola, M. Vezzoli, F. Salvucci, C. Valenti, A. Giustina, A. Garzaniti, Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J. Am. Coll. Cardiol. 51, 2040–2044 (2008)PubMedCrossRefGoogle Scholar
  88. 88.
    C. Gazzaruso, A. Coppola, A. Giustina, Erectile dysfunction and coronary artery disease in patients with diabetes. Curr. Diabetes Rev. 7, 143–147 (2011)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Andrea Sansone
    • 1
  • Francesco Romanelli
    • 1
  • Daniele Gianfrilli
    • 1
  • Andrea Lenzi
    • 1
  1. 1.Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine“Sapienza” University of RomeRomeItaly

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